Cardiac protective effect of levosimendan in patients with tako-tsubo cardiomyopathy

Objective To investigate the cardiac protective effect of levosimendan in patients with tako-tsubo cardiomyopathy (TTC). Methods A total of 31 TTC patients collected from Department of Intensive Care Unit, the 2nd Affiliated Hospital of Wenzhou Medical University from January 2006 to December 2016 were retrospectively studied, who were divided to the treatment group (n = 12) and the control group (n = 19) according to the use of levosimendan. Patients in the treatment group were used levosimendan strictly according to the instructions with the initial loading dose of 6~12 μg/kg through intravenous infusion for more than 10 min, followed by continuous minipump infusion of 0.1 μg·kg-1·min-1. The control group did not use levosimendan. The general data and related cardiac indexes which included the left ventricular ejection fraction (LVEF), the left ventricular end diastolic dimension (LVDD), the cardiac troponin I (cTnI) and the pro-brain natriuretic peptide of TTC patients in the two groups were compared. At the same time, patients were followed up for an average of 22.3 months to record their long-term survival. Results The acute physiology and chronic health evaluation (APACHE) Ⅱ scores [(18 ± 4) vs. (16 ± 4), t = 2.057, P = 0.049] and the ICU length of stay [(16 ± 5) d vs. (21 ± 6) d, t = 2.110, P = 0.044] of patients in the two groups were significantly different. The LVEF of patients in the treatment group was higher as compared to the control group [(59 + 9) % vs. (52 + 8) %, t = 2.062, P = 0.048]. The peak values of cTnI [(8.7 ± 3.2) μg/L vs. (11.4 ± 3.6) μg/L, t = 2.120, P = 0.043] and pro-brain natriuretic peptide [(3 656 ± 1 043) ng/L vs. (4 753 ± 965) ng/L, t = 2.989, P = 0.006] in the treatment group were lower than those in the control group. There was no significant difference in the overall survival of the two groups with 3 cases of death in the treatment group and 6 cases of death in the control group (P = 0.325). Conclusion Levosimendan has the potential to promote the recovery of cardiac functions, reduce the injury of cardiac myocytes and shorten the ICU length of stay in TTC patients, but it has no effect on their overall survival. Key words: Levosimendan; Tako-tsubo cardiomyopathy; Protective effect